El-Kaissi S, AbdelWareth L, Dajani R, et al. - According to this randomized prospective design, patients who take levothyroxine 30 minutes before the Iftar meal are less likely to experience unfavorable changes in plasma thyroid-stimulating hormone (TSH) after Ramadan. Instructing patients to take levothyroxine 3 hours after Iftar or 30 minutes before Suhur, on the other hand, resulted in a larger increase in post-Ramadan TSH.

• During Ramadan, hypothyroid patients using levothyroxine were randomly assigned to one of three groups: (group 1) at dusk 30-minutes before Iftar meal, (group 2) 3 or more hours after Iftar meal, or (group 3) at dawn 30-minutes before Suhur meal.

• For 148 patients, group 1 (n = 50), group 2 (n = 46), and group 3 (n = 52), plasma TSH levels were available at one or more time points.

• Pre-Ramadan, patients in groups 2 and 3 saw a statistically significant increase in plasma TSH, whereas those in group 1 did not.

• Only participants in group 1 who were at the 75th percentile had a statistically significant drop in plasma TSH.

• There were no statistically significant within-patient changes in patients at the 50th percentile prior to Ramadan, while descriptively, elevations in plasma TSH were reported in groups 2 and 3, whereas a drop was observed in group 1.